[Question #1981] STI

49 months ago
Drs,  I apologize for once again finding myself here.    But since I was here last in Jan., different objective issues have popped up.   To refresh your recollection - my exposure was protected oral and vaginal with a CSW on 12/2/2016.

When I last spoke to Dr. Handsfield, I had one dermatologist diagnose me with genital warts.     My PCP, 2 other dermatologist, and my urologist all said its not an STD.    The consensus was contact dermatitis or possible fungal infection.  Prescribed ketoconazole ointment for 2 weeks.     Condition did not subside.     7 weeks later, the rash got better BUT never left.    Urologist conducted biopsy on 3/6/2017 (3+ months after exposure)    Pathology Rpt: "Penile rash, biopsy: skin with minimal chronic inflammation.  GMS stain: Negative (-) for fungal organisms."  

1.   Is this conclusive that it wasn't genital wart?    I ask because they ran the statin to detect fungus but no mention of anything else.   Is a special stain needed to detect GW?

2.   Can this possibly be herpes?    They didn't run the statin for it or at least there was no mention of it.   I mean, I highly doubt it given that it lasted 7+ weeks with no blisters developing.   Just a rash with bumps.    

On 3/17/2017 - Found small traces of blood in semen inside condom.  No trauma to the area.  No bike riding.   PCP ran urine tests for Chlamydia/Conor/Trich/urinalysis/culture.   All negative or normal.   Also ran blood tests for PSA (normal)  and HSV-2  (negative).  The HSV-2 was an IGG type specific test at 16 weeks post exposure.

On 4/12/2017 - Discovered another rash on penis.  This one is located in a different area than the one biopsied.     This one is right on the head, next tot he urethra.      At first I thought it was just irritation caused by urine, but a day later, its still there.  There seems to be a small bump or 2 in the rash.    It doesn't hurt to urinate.  Feels like razor burn.       
49 months ago
Continuation from initial post.

Questions 3 & 4.

3.    Is there anything else from an STD standpoint that could've caused the blood in semen?     For good measure, I've also tested negative  MGEN thru labcorp.    

4.   Any chance that the new rash is herpes?       This is what I am most concerned with right now.

I've already tested negative for HSV-2 at 16 weeks.   Did not test for HSV-1 as I already have it orally.     I understand its rare to get HSV-1 genitally if one already has it orally.  Terri said she's seen 1 case in her 30+ years.     Since my exposure on 12/2/2016, I've only had protected sex with my spouse and the last occurrence was on 3/31/2017.     The only other rash I've seen was the one that was biopsied.

Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
Sorry to see you back. You were warned last time about not re-posting further questions about the same exposure and symptoms. I'll answer these additional questions succinctly, but this really must be the last time.

1) I have not examined you, this forum is not a substitute for in-person care, and I cannot make a diagnosis. In our previous discussion, I gave you some reasons why I was skeptical about warts, and now 4 physicians, including two dermatologists and a urologist, have given you alternate diagnoses and reassured you about warts. Why wouldn't you believe them?

2,4) Herpes doesn't behave at all liks this and your negative HSV2 blood test is conclusive; and since you already have HSV1, that virus cannot cause a new infection anywhere on your body. And as I recall, there was other evidence against herpes that was discussed in your previous threads. So for sure this isn't herpes.

3) No STDs normally cause blood in semen. That's an occasional occurrence in healthy men. Also, some cases result from minor trauma to the perineum (the area between anus and scrotum), e.g. from bicycling or horseback riding. In any case, if this continues, you should consider seeing a urologist.

In closing, I'll add that the large majority of genital rashes and other skin problems are not STDs. On the shelf next to me as I type this reply is a book titled Genital Dermatology Atlas. As the titlle suggests, is filled with photos and discussions of genital skin problems. Among its 300 pages, exactly 15 are devoted to STDs. Given the strong evidence that you have no STD to explain the problem, you should put that notion to rest. These problems clearly are unrelated to any sexual exposures you have had recently or in the past. And we have already discussed why the exposure last December carried little or no STD risk.

So please do your best to move on without worry. Continue to work with your current doctors if your symptoms continue and you remain concerned (but pick just one, probably one of the dermatologists, and stop seeking multiple opinions). Do your best to put behind you last December's sexual exposure and your apparent guilt or shame over it. And try to separate your anxieties over a sexual decision you regret from potential medical consequences of that decision. Deal with the former as you need to, but you truly can put the latter out of your mind.

Sorry if all this seems a bit harsh. Call it tough love, if you like. But it truly is time for you to move on.

HHH, MD

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